Provider Demographics
NPI:1598818692
Name:FRANCIS, SALLY GRACE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:GRACE
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1752
Mailing Address - Country:US
Mailing Address - Phone:510-549-1152
Mailing Address - Fax:
Practice Address - Street 1:345 38TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2703
Practice Address - Country:US
Practice Address - Phone:510-549-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14551103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist